Abnormal Gallium Scan- is it PCP pneumonia or is it from my chemotherapy? My doctor is a total jerk!Dec 23, 2001

The cytoxan chemotherapy which I received in the first two rounds of chemo caused a severe inflammatory response in my lungs, diagnosed by bronchoscopy in 8/2001. I was treated with Prednisone. I had a routine Gallium Scan in 12/2001 and had Gallium uptake in my lungs. My chest x-ray shows infiltrates. I have no fever, no night sweats,no enlarged lymphnodes,no shortness of breath, and no cough. I feel great, working full time except when doing chemotherapy 3 days every 21 days.My primary care provider is trying to say I'm sick and I resent that because I know my body and it pisses me off that he trying to say i have pneumonia and he would just love it if it were pneumocystis pneumonia. I think its still an inflammatory response in my lungs from the 3 rounds totalling 16 months of chemo.I don't have any respiratory distress and I've been walking up San Francisco hills even after my Gallium Scan,so if I had pneumonia i won't be able to do that, right? My doctor is a total jerk.

Response from Dr. Dezube

The question you are asking, if I understand you correctly, is whether you abnormal gallium scan is due to residual inflammation from your chemotherapy or due to pneumonia. I do agree with you that in the absence of fever, shortness of breath, fevers, and cough, it's hard to give you a diagnosis of pneumonia. However, patients with cancer (e.g. lymphoma) and on chemotherapy are more susceptible to pneumonias so you may not be off the hook just yet. What's your CD4 count? (if it's low then obviously you are even more susceptible); are you on pneumocystis prophylaxis? Would you be willing to go through a sputum induction? (you have nothing to lose).

That said, you may indeed have chemotherapy-induced inflammation. Lung inflammation from chemotherapy is relatively uncommon, but you've already had a bronchoscopy which showed that. Obviously a repeat bronchoscopy would hopefully give you all the answers you need. Whether your current situation merits another procedure is not clear. Time will probably tell since if you have pneumonia, it certainly won't get better without any treatment. Is you lung inflammation in 12/2001 at least better than that in 8/2001?

As for your primary care provider, I obviously can't comment on him. You said he would love it if you have pneumocystis pneumonia. This is probably only because
he views that diagnosis as readily treatable. I wouldn't be too hard on him as your diagnosis is anything but clear. Lastly, what do your pulmonologist and HIV doctors think?? Good luck! BD.

PS: I'm impressed that you can walk up those San Francisco hills. They can be challenging even for me.

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